Arantes Vitor N, Ramos Josué Aliaga, White Jonathan Richard, Parra-Blanco Adolfo
Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Brazil.
Faculty of Medicine, Cayetano Heredia Peruvian University, Digestive Endoscopy Unit of San Pablo Clinic, Surco, Lima, Department of Gastroenterology, "Jose Agurto Tello" Hospital, Lima, Peru, Associate member of the Society of Gastroenterology of Peru.
Endosc Int Open. 2022 Jun 10;10(6):E753-E761. doi: 10.1055/a-1789-0266. eCollection 2022 Jun.
Esophageal strictures (ES) occur frequently after semi-circumferential endoscopic submucosal dissection (ESD) for the eradication of superficial esophageal neoplasms and negatively impact a patient's quality of life. Oral corticosteroids have been shown to be clinically effective, but the most appropriate drug, dose and duration is yet to be determined. The aim of the study was to investigate the clinical effectiveness and safety of 30 mg prednisone with a shortened tapering schedule on ES after semi-circumferential ESD. This was a retrospective observational study that analyzed consecutive patients with esophageal neoplasms who underwent semi-circumferential ESD with a resection defect greater than 75 % of the circumference that received a protocol of oral steroids for stricture prevention. On postoperative day 3, 30 mg prednisone was prescribed, tapering weekly to 20 mg/10 mg/5 mg over 4 weeks. Follow-up included clinic consultation and endoscopic review at weeks 2 and 4. Effectiveness outcomes included ES rates, safety, tolerability, resection, dilatation and recurrence rates. Ninety ESD procedures were carried out during the specified time period and 18 patients met the inclusion criteria for the final analysis. The mean age was 61.5 years, lesion size was 52.5 mm, and final histology was squamous cell carcinoma in all patients. Incidence of intra-procedure complications was: bleeding 5.5 % (1/18) and ES 5.5 % (1/18), requiring a median two endoscopic dilatations. En bloc, R0 and curative resection rates were 88.8 %, 72.2 %, and 55.5 %, respectively. The short tapering schedule of 30 mg oral prednisone is clinically efficacious and safe for prevention of ES after semi-circumferential ESD in Latin American patients.
在采用半环周内镜黏膜下剥离术（ESD）根除浅表性食管肿瘤后，食管狭窄（ES）频繁发生，对患者的生活质量产生负面影响。口服皮质类固醇已显示出临床疗效，但最合适的药物、剂量和疗程尚未确定。本研究的目的是调查30毫克泼尼松并采用缩短的减量方案对半环周ESD术后食管狭窄的临床疗效和安全性。这是一项回顾性观察研究，分析了连续接受半环周ESD且切除缺损大于圆周75%的食管肿瘤患者，这些患者接受了预防狭窄的口服类固醇方案。术后第3天，开具30毫克泼尼松，在4周内每周减量至20毫克/10毫克/5毫克。随访包括在第2周和第4周进行临床会诊和内镜复查。疗效指标包括食管狭窄发生率、安全性、耐受性、切除率、扩张率和复发率。在指定时间段内进行了90例ESD手术，18例患者符合最终分析的纳入标准。平均年龄为61.5岁，病变大小为52.5毫米，所有患者的最终组织学检查均为鳞状细胞癌。术中并发症发生率为：出血5.5%（1/18），食管狭窄5.5%（1/18），中位需要两次内镜扩张。整块切除率、R0切除率和根治性切除率分别为88.8%、72.2%和55.5%。对于拉丁美洲患者，30毫克口服泼尼松的短程减量方案在预防半环周ESD术后食管狭窄方面具有临床疗效和安全性。
